Eric Zehr is vice president of Addiction & Behavioral Services at Proctor Hospital, where he oversees the operations of the Illinois Institute for Addiction Recovery, the outpatient mental health counseling center, Social Services, Food and Nutritional Services, and the Cardiac Catheterization Laboratory.

Zehr has treated addicts since 1987. In May 1993, he helped develop and implement the first specialized, comprehensive gambling addiction treatment program in Illinois, and in 1996, he helped develop and implement the nation’s first comprehensive Internet addiction treatment program. He’s helped develop the Illinois Institute for Addiction Recovery into the world’s leading comprehensive multiple and specialty addiction treatment provider.

Zehr has educated Fortune 500 companies, universities, and municipalities on how to identify and treat addictions. He’s also consulted on addiction-related stories to the writers and producers of Chicago Hope and assisted media including Sports Illustrated; Newsweek; Working Woman; National Public Radio; CAPA-TV in Barcelona, Spain; NBC Nightly News; ABC World News Tonight; ABC’s 20/20; CBS’ 48 Hours and The Early Show; Fox Sports News; Kiplinger’s Retirement Report; Redbook magazine; the Seoul Broadcasting Corporation; and The South China Morning Post (Hong Kong).

Zehr is editor/publisher of Paradigm magazine, an award-winning publication distributed internationally to educate health care professionals on behavioral medicine issues and treatment techniques. He’s the past president of the Illinois Hospital Addiction Treatment Administrators Forum, a member of the Illinois Hospital Association’s Behavioral Health Steering Committee, and a member of the Great Lakes Addiction Technology Transfer Center’s Advisory Committee. He’s also served on numerous area advisory councils and is the current president of the Consumer Credit Counseling Services of Central Illinois’ Board of Directors.

Tell us about your background, schools attended, family, etc.

I was born and raised in Pontiac, where my brother and parents still reside. I grew up in a family business; my grandfather and father operated Zehr Hatchery & Mill, which hatched, raised, and shipped millions of ready-to-lay chickens across the United States every year. This line of work demanded attention 24 hours a day, seven days a week and provided me a work ethic that’s allowed me to be successful in the health care industry. I earned a bachelor’s degree in psychology at Eastern Illinois University in 1984 and received my master’s degree in clinical psychology from Illinois State University in 1987.

Over the years, I’ve become a certified Supervisor of Alcohol and Other Drug Abuse Counselors (CSADC), a certified Problem and Compulsive Gambling Counselor (PCGC), and board registered at the Mental Illness Substance Abuse II (MISA II) level through the Illinois Alcohol and Other Drug Abuse Professional Certification Association (IAODAPCA). The American Compulsive Gambling Counselor Certification Board, Inc., the National Council on Problem Gambling, Inc., and the American Academy of Healthcare Providers in the Addictive Disorders have recognized me as a compulsive gambling counselor certification trainer.

My wife, Jenny, is the director of Information Services at Proctor Hospital. We live in Peoria and have one daughter.

Who or what influenced you to specialize in addiction counseling?

In graduate school, I specialized in working with adolescents and completed some coursework in neuropsychology, where I had my first academic exposure to the affects of chemical addiction. I had no intention of working in addiction medicine until I began counseling an adolescent while working for Catholic Social Services in Bloomington during the final year of my master’s degree program. When I began working with that particular client, he was a young addict in need of treatment. I worked with him before, during, and after his inpatient treatment experience. I was amazed at the cognitive, emotional, physical, and spiritual changes he made in such a short period of time-not as a result of my work, but as a result of his chemical dependency treatment. That made a lasting impression on me. It was shortly after that experience that I, nearing graduation, responded to an ad placed by Proctor Hospital’s Chemical Dependency Center seeking an addiction counselor. I knew at the time I didn’t know much about addiction treatment, but I was willing to learn what made it so powerful. I started as an addiction counselor on the adult unit in June 1987 and still call the Illinois Institute for Addiction Recovery at Proctor Hospital home.

Describe your responsibilities at Proctor Hospital.

I’m responsible for the overall operations of several departments at Proctor Hospital including the Illinois Institute for Addiction Recovery, the outpatient mental health counseling center, Social Services, Food and Nutritional Services, and the Cardiac Catheterization Laboratory. I’m also active in assisting the organization to maintain Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation and with our performance improvement efforts we call the Quality Leadership Process.

Talk about the Illinois Institute for Addiction Recovery at Proctor: its history, programs, national recognition, etc.

In 1978, the Proctor Hospital Board of Trustees elected to begin treating chemical dependency. Later that year, staff were selected and trained at Hazelden in Center City, Minn. In February 1979, a 33-bed unit was opened, and John Schwarzlose became the unit’s first executive director. In 1981, John was selected by Betty Ford to help her open the Betty Ford Center in Rancho Mirage, Calif. Still today, John is the president of the Betty Ford Center. Dennis Pope became the next executive director, and under his guidance, Proctor developed innovative outpatient, codependency, and variable length of stay services for adults, adolescents, and families. In June 1992, Dennis departed for Eau Claire, Wis., and I became the interim executive director.

The staff of the IIAR started the nation’s most comprehensive gambling addiction treatment program in 1993, began program development consulting services in 1994, and started publishing our award-winning Paradigm magazine in 1995. In 1996, we started our food addiction and sex addiction treatment programs and the nation’s first comprehensive Internet addiction treatment program. We’ve provided gambling training to thousands of clinicians at various sites across the nation, from Hawaii to Puerto Rico. We regularly provide consultation and information on all addictions to national radio and television news programs. One such opportunity involved working with the producers and writers of Chicago Hope over several seasons as they developed a lead physician character, played by Mark Harmon, into a pathological gambler. The information we gave them was often integrated into his dialogue verbatim. We believe that helped remove some of the hidden nature of gambling addiction and brought to light how addiction can affect anyone, with no bias to gender, employment, socio-economic status, etc. Some of those writers have gone on to other programs and still incorporate the information we provided them in new programs. In 1997, we were invited to speak on gambling addiction at international conferences and began to treat gamblers from around the globe.

As the growth of the IIAR continued, a need arose for more space to treat patients. In 1999, a new facility housing our inpatient Adult Unit, inpatient Young Adult Unit, and administrative offices was built on the south side of the Proctor campus. One of our generous co-medical directors, Dr. Ameel Rashid, provided a naming gift for the building. By 2000, we began treating our first international patients and accepted our first international intern from Germany. Just last year, we established the nation’s first Chronic Pain with Addiction Treatment program and expanded our services to include an extended care treatment program that provides long-term treatment for those needing more than 90 days of care. In May, we were proud to share a stage with former President Gerald Ford and receive the prestigious 2003 James W. West, M.D. Quality Improvement Award from the National Association of Addiction Treatment Providers. We opened a new facility in Springfield August 1 and began online therapy services for our patients who came to us from a distance.

How does treatment for various addictions differ?

There are many similarities and differences between the addictions we treat. The common thread is that every addiction is a chronic, progressive, incurable disease. However, the hope lies in the fact that addiction is treatable, and no one has to die from addiction. While there are some differences between chemical (alcohol and other drugs) and process (gambling, spending, food, sex, Internet) addictions, those differences are primarily rooted in how the addict obtained the "drug" of choice. What’s more important is all of the addictions we treat have many more similarities than differences because the disease process is the same for all addictions, despite what "vehicle" brought the addict to the party. In addition, loss of control, the hallmark for the disease, is the same no matter what the primary addiction. Once addicted, the person can’t quit and remain so without assistance. Because of the disease, addicts begin doing things they wouldn’t otherwise have done, and, once their addiction begins controlling them instead of them controlling it, they need help from others to arrest the disease process.

How can family members or colleagues best help someone they suspect is suffering from an addiction problem?

It was once believed a person struggling with addiction had to sincerely want help to get help. This, of course, isn’t always true. An addicted person can’t easily survive without support from someone close to them. A person who’s addicted will continue to live their life of active addiction when family, friends, and co-workers offer inappropriate support. This type of support typically allows the addiction to continue. Although, in most cases, family, friends, and co-workers feel they’re protecting the person, they are, in fact, creating an unhealthy support system for the addicted person.

An intervention can address the unhealthy support system that allows the addiction to progress. It creates a support system that allows the addict to grow and change in a positive way. Formal, professionally lead interventions typically include two to eight concerned persons who may be family, friends, supervisors, co-workers, ministers, etc. During the intervention, the addict is asked to make a decision. This could likely be the most important decision of their life. Under normal circumstances, the addict may not be willing to make a decision to seek the help that’s needed. During the intervention, however, they may become more open to help. This decision is brought about through caring support, not anger. The most important people in the addict’s life make the request for change. Once the addict begins receiving treatment, denial starts to fade and a stronger, more positive attitude begins to develop. Intervention is an expression of concern, not retribution.

We have a team of trained interventionists that will fly anywhere in the country, train a family or employer on our invitational model of intervention, facilitate the intervention, and then fly back to treatment with the addict. No other facility in the country has a team of interventionists with the expertise and experience in working with chemical, gambling, spending, food, sex, and Internet addicts that we have.

What’s the success rate for a person entering inpatient treatment? What are the critical success factors necessary for recovery?

Success can be measured many different ways. Most people think of it in terms of continued abstinence. Some also consider success based on improved work performance. Continued abstinence is achievable if the addict follows our simple recommendations after treatment. Our studies indicate that, six months post treatment, nearly 85 percent of our patients are still abstinent. The national average is around 50 percent.

The critical success factors necessary for ongoing recovery after primary treatment include regular attendance at aftercare group meetings; individual, family, and possibly employer sessions; not using/engaging in addictive behavior; regular attendance at 12-step self-help support group meetings (changing "playgrounds" and "playmates"); obtaining a recovering sponsor; and actively working the steps of recovery on a daily basis.

How do various addictions affect family members? How does addiction affect businesses?

Chemical, gambling, spending, food, sex, and Internet addictions are family diseases, affecting an estimated one out of three families in the United States. The addicted person’s behavior has a negative effect on at least four people beside himself, especially those to whom he’s closest.

The long-term result of living with an addicted individual is a condition called co-dependency. The condition often spawns feelings of chronic anger and resentment, affects the ability to trust and feel intimate, and can lead to serious emotional problems. Without direct family treatment, the effects of co-dependency continue to hurt the family, particularly children, even if the addict stops using or gambling.

Unfortunately, family members sometimes view addiction as someone else’s problem and refuse to become involved. Families must recognize that seeking help for themselves doesn’t mean responsibility for an addict, but responsibility to the addict and other family members. Families locked into old patterns of feeling and behavior complicate the addicted person’s recovery and burden themselves unnecessarily with feelings of pain, resentment, and detachment.

The Illinois Institutes for Addiction Recovery’s Family Services help family members understand how living with an addicted person hurt them and their interactions. We aid family members in developing personal insights and new ways of dealing with and living with an addicted person. Children living with an addicted person often develop behavior and personality patterns that have long-term effects on their lives. These children have difficulty communicating and trusting others. This results in frequent physical complaints, acting-out behavior, low self-esteem, and isolation. Without help, these children continue to experience problems both at home and school. Often, children’s problems aren’t recognized as being related to the family disease of addiction. And too often, these children don’t receive the help they need and deserve.

Growing up in an addicted family can leave permanent emotional scars on an individual, affecting behavior patterns and personal relationships into adulthood. The stress of an addicted family may even cause physical problems later in life. But through individual counseling, peer group interaction, and support, these problems often can be overcome.

The most valuable resource of any company, large or small, is its people. Without healthy, productive, capable employees, no business can remain competitive and profitable.

Addictions can dramatically affect an employee’s ability to contribute to your company’s success. In economic terms, an addiction can lead to a drop in productivity, reduced product quality, increased absenteeism, and higher health care costs. In human terms, an addiction can lead to failed marriages, broken homes, severe emotional problems, and even death. Depending on the nature of the individual’s work, public safety can be jeopardized.

Because an addiction impacts every facet of a person’s life, the problem must be addressed at many different levels, including the place of employment. The Illinois Institute for Addiction Recovery at Proctor Hospital allows employers to offer a comprehensive program of evaluation, treatment, counseling, and support for employees and their families. The following information may help you determine if an employee or co-worker is having a problem with alcohol or drugs: change in work attendance or performance, alteration of personal appearance, mood swings or attitude changes, withdrawal from responsibility or associate contacts, unusual patterns of behavior, and defensive attitude concerning the object of addiction.

In the early phase of an alcohol addiction, an employee drinks to relieve tension, his alcohol tolerance increases, he experiences blackouts, and lies about his drinking habits. He arrives late for work, leaves early, and is often absent from work. He overreacts to real or imagined criticism, complains of not feeling well, lies, and fellow workers often complain about the individual. He misses deadlines, makes mistakes because of inattention or poor judgement, and experiences decreased efficiency.

In the middle phase, he drinks surreptitiously, feels guilty about drinking, experiences tremors during hangovers, and experiences a loss of interest. He takes frequent days off for vague ailments or implausible reasons. His statements become undependable, he begins to avoid associates, borrows money from co-workers, exaggerates work accomplishments, is hospitalized more than average, has repeated minor injuries on and off the job, and feels unreasonable resentment. His job performance deteriorates, he has a spasmodic work pace, wandering attention, and a lack of concentration.

In the late middle phase, he avoids discussing his problems, fails in efforts at control, neglects food, and prefers to drink alone. He takes frequent time off work-sometimes for several days-and fails to return from lunch. His general behavior is grandiose, aggressive, or belligerent, domestic problems interfere with work, he has an apparent loss of ethical values, experiences loss of money, hospitalizations increase, and has trouble with the law. His job performance is far below the expected level.

In the late phase, he believes other activities interfere with drinking. He has prolonged unpredictable absences. He drinks on the job, is totally undependable, has visible physical deterioration, worsening financial problems, and serious family problems. His job performance is uneven and generally incompetent.

In the mid-1980s, Henry Lesieur, Ph.D., researched the effects of problem gambling in the workplace. He identified the following warning signs that may indicate an individual has a gambling problem:

• Excessive use of telephones (to call bookmakers, stockbrokers, or to obtain credit).
  
• Taking the company vehicle to the race track, card room, casino, etc. (parking tickets near gambling locations are a red flag).
  
• Absences from work, often for part of the day and typically after lunch.
  
• Arriving late for work (related to all-night card games, casino trips, anxiety-related sleep disturbances).
  
• Vacation days taken on isolated days rather than in weeks (or vacations taken to gambling locations on a regular basis).
  
• Sick days taken immediately or ahead of time.
  
• Failure to take days off (obsessed with getting money to pay gambling debts or afraid to take a day off because of a fear that embezzlement or fraud will be discovered in their absence).
  
• Changes in productivity that seem to be related to mood swings.
  
• Organizing office pools and gambling junkets.
  
• Borrowing money from co-workers or arguing with co-workers over failure to pay debts.
  
• Embezzlement, defrauding customers, or engaging in employee theft for resale.

What lifestyle changes are critical to the recovering addict?

It’s critical that addicts treat their disease on a daily basis by working the 12 steps of recovery, attending 12-step meetings regularly, and actively engaging their recovering sponsor-all in an effort to change "playgrounds and playmates" and develop a healthy support system.

What are the common misperceptions of addicts beginning their recovery?

Addicts often feels guilty because they’ve made mistakes, but, more devastatingly, they often feel ashamed-like they are a mistake. They also often feel very alone in their pain, which is why it’s so important for them to begin attending treatment and 12-step support group meetings to quickly recognize they aren’t alone, and hope, health, and support is available to them. Initially, it’s also difficult at times for the addict to understand recovery is a process, not an event.

What makes the Illinois Institute for Addiction Recovery unique to programs in other parts of the world?

We’re the world’s leading and most comprehensive multiple and specialty addiction treatment provider. As a result, we treat addicts from around the globe, even as outpatients. Our treatment staff, which includes physicians, psychologists, addiction counselors, financial counselors, registered nurses, and program assistants, have all received extensive training and/or certification in all of the addictions we treat. Because we’re a state-of-the-art treatment center, we often are the first to develop necessary training for ourselves and then offer it to other clinicians around the country for a fee. We developed the first comprehensive gambling addiction treatment program in Illinois in 1993 and the nation’s first comprehensive Internet addiction treatment program in 1996. Last year, we started the nation’s first comprehensive chronic pain with addiction treatment program that includes physicians board certified in physical medicine and rehabilitation, anesthesiology, and psychologists with expertise in pain management. We also started an extended care program that provides long-term treatment for adults and adolescents needing at least 90 days of structured programming to assist in their early recovery efforts.

Aside from treatment, we have a training institute that provides gambling counselor certification training and workshops on all addictions we treat to clinicians from across North America. We also publish Paradigm magazine, which is distributed quarterly around the world to help educate other clinicians and the general public on a variety of addictions, other behavioral health issues, and treatment techniques.

Are there certain factors that would promote an increase in the number of addictions seen in a community?

The more available access to a "drug" is, the higher the prevalence of addiction to that drug, whether it’s a chemical, a type of gambling, credit for shopping/spending, etc. Over the past 10 years, we’ve seen an increased prevalence of gambling addiction rising with an increase in casinos, OTBs, and lottery sites. A more recent phenomenon is the rise in Internet addiction, with an increased accessibility to the Internet for people at home and work. In addition, the Internet has also been a vehicle to increasing other addictions such as gambling, spending, and sex. Cultural customs and mores, levels of denial, and genetics also play a part in a community’s addiction prevalence.

How do heredity and environment affect the propensity for a person to succumb to addictive behaviors?

Most genetic research focused on addiction has involved alcoholism and drug dependency, although some has focused on gambling and other process addictions. Although family studies, twin studies, and adoption studies have indicated alcoholism is heritable, that doesn’t mean environment has no affect. Clearly, the availability of alcohol, drugs, gambling, the Internet, etc. is a factor of the environment that can determine whether a person becomes addicted or not. The interaction between genes and the environment is very important, and these factors influence the possibility of developing an addiction.

Has there been an increase in referrals from businesses for treatment?

In general, yes, there’s been an increase in the past decade, and employers whose supervisors have been trained to identify the signs and symptoms of addiction tend to intervene earlier in the addict’s disease process. This often means the employee needs a less structured treatment program, so they can attend treatment on an outpatient basis and not miss any work. We provide this supervisory training for companies across the nation at no charge. It typically lasts only an hour or two. In addition, we’re available to assist supervisors during an employee intervention.

With rising health care and insurance costs, has there or will there be an increase in people not seeking treatment?

We work closely with all insurance companies to assure proper insurance coverage throughout every level of care for all of our patients. To date, we haven’t experienced a reduction in people seeking treatment here. In fact, we’re experiencing a dramatic increase in the number of addicts we treat from outside Illinois, outside of the Midwest, and outside of the country. In addition to our facility in Bloomington, we opened a new facility in Springfield in August to better serve those seeking help from the southern half of the state.

What would you like our readers to know about addictions and recovery?

Addictions are chronic, progressive, incurable diseases. Every aspect of an addict’s life will spiral downward during active addiction. However, active addiction can be arrested at any point in the disease process before death, and recovery can begin. I’ve witnessed this first hand and recall an addict who, after first being resuscitated in the Proctor emergency room and stabilized physically on a Proctor medical floor, later transferred to our Addiction Recovery Center and has now enjoyed more than a decade of recovery. Dramatic changes occur in a relatively short period of time when people seek treatment. In just a few days or weeks, they often begin seeing positive physical, emotional, psychological, spiritual, and work-related changes. For me, that’s what’s so enjoyable about treating addicts-the miraculous changes that can unfold so quickly and last a lifetime. IBI